Evaluation of a screening algorithm using the Strengths and Difficulties Questionnaire to identify children with mental health problems: A five-year register-based follow-up on school performance and healthcare use

Abstract

BackgroundTreatment of mental health problems (MHP) is often delayed or absent due to the lack of systematic detection and early intervention. This study evaluates the potential of a new screening algorithm to identify children with MHP.MethodsThe study population comprises 2,015 children from the Copenhagen Child Cohort 2000 whose mental health was assessed at age 11–12 years and who had no prior use of specialised mental health services. A new algorithm based on the Strengths and Difficulties Questionnaire (SDQ) is utilised to identify MHP by combining parent-reported scores of emotional and behavioural problems and functional impairments. The screening is done on historical data, implying that neither parents, teachers nor health care professionals received any feedback on the screening status. The screening status and results of an IQ-test were linked to individual-level data from national registries. These national registers include records of each child’s school performance at the end of compulsory schooling, their health care utilisation, as well as their parents’ socio-economic status and health care utilisation.Results10% of the children screen positive for MHP. The children with MHP achieve a significantly lower Grade Point Average on their exams, independently of their IQ-score, perinatal factors and parental characteristics. On average, the children with MHP also carry higher health care costs over a five-year follow-up period. The higher health care costs are only attributed to 23% of these children, while the remaining children with MHP also show poorer school performance but receive no additional health care.ConclusionsThe results demonstrate that children with MHP and a poor prognosis can be identified by the use of the brief standardised questionnaire SDQ combined with a screening algorithm.

Cost-effectiveness of a Transdiagnostic Psychotherapy Program for Youth With Common Mental Health Problems

“…It is hypothesized that MMM will generate long-term preventive effects by lowering the risk of future severe mental disorders [13]. If this is the case, MMM may be considerably more cost-effective than our results suggest, both due to the health effects but also due to the potential cost savings, as contacts to CAMHS are associated with very large health care costs [29].…”

“…A two-stage standardized visitation was implemented in the Educational-psychological advisory service in the four participating municipalities to identify study participants [28]. Eligibility criteria were: 1) Age between 6 to 16 years, 2) being in 0-9th grade, 3) having a parent-reported score on The Strength and Di culties Questionnaire (SDQ) above a cut-off based on top 10% percent of mental health problems in the general age-matched Danish population [29], and 4) having anxiety, depressive symptoms, or behavioral problems as the top-problem based on the standardized assessments in the visitation procedure. Youth with prior diagnosis of any developmental or mental disorder, including autism spectrum disorder, attention-de cit/hyperactivity disorder, psychotic disorder, eating disorder, severe obsessive-compulsive disorder, repeated self-harm, alcohol or psychoactive drug abuse, or with signs of intellectual disability were not eligible for the trial.…”

Effectiveness of Transdiagnostic Cognitive-Behavioral Psychotherapy Compared With Management as Usual for Youth With Common Mental Health Problems

“…Inclusion criteria consisted of (1) age of 6 to 16 years and in compulsory school; (2) anxiety symptoms, depressive symptoms, and/or behavioral disturbances as top problem; and (3) parent-reported SDQ Total Difficulties score of at least 14, Emotional Problems score of at least 5, and/or Conduct Problems score of at least 3, combined with an Impact score of at least 1 (ie, cutoff for 90th percentile of mental health problems in the general age-matched population). Exclusion criteria consisted of (1) prior clinical diagnosis of any developmental or mental disorder; (2) signs of intellectual disability or severe mental disorder, including autism-spectrum disorder, attention-deficit/hyperactivity disorder, psychotic disorder, eating disorder, obsessive-compulsive disorder, repeated self-harm, or alcohol or psychoactive drug abuse; (3) youth or parents unable to participate in weekly sessions; and (4) participation in the prior feasibility study ( Supplement 1 ). Thus, we included help-seeking youths with emotional and behavioral problems that were above the 90th percentile in the general population of youth and still below the threshold for referral to specialized treatment in the child and adolescent mental health services.…”

The longitudinal validity of proxy-reported CHU9D

“…The inclusion procedure included minimum scores derived from the SDQ as reported by the parents and a clinical interview with a psychologist. The minimum scores from the SDQ follow a screening algorithm designed to identify children with mental health problems in the need of an intervention, this is further described elsewhere [19]. To be included in the trial, the child had to have a primary problem that falls within the domains of anxiety, depressive symptoms or behavioral problems, according to the classification by the psychologist conducting the interview.…”